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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2018, Vol. 07 ›› Issue (01) : 48 -52. doi: 10.3877/cma.j.issn.2095-3232.2018.01.013

所属专题： 文献；

临床研究

腹腔镜肝切除术治疗困难部位肝细胞癌的疗效
刘钦钦1, 胡逸凡1, 刘非1, 魏永刚1, 李波1,†()   
  1. 1. 610041　成都，四川大学华西医院肝脏外科
  • 收稿日期:2017-11-19 出版日期:2018-02-10
  • 通信作者: 李波

Efficacy of laparoscopic liver resection for patients with hepatocellular carcinoma at complicated region

Qinqin Liu1, Yifan Hu1, Fei Liu1, Yonggang Wei1, Bo Li1,†()   

  1. 1. Department of Hepatic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
  • Received:2017-11-19 Published:2018-02-10
  • Corresponding author: Bo Li
  • About author:
    Corresponding author: Li Bo, Email:
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刘钦钦, 胡逸凡, 刘非, 魏永刚, 李波. 腹腔镜肝切除术治疗困难部位肝细胞癌的疗效[J]. 中华肝脏外科手术学电子杂志, 2018, 07(01): 48-52.

Qinqin Liu, Yifan Hu, Fei Liu, Yonggang Wei, Bo Li. Efficacy of laparoscopic liver resection for patients with hepatocellular carcinoma at complicated region[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2018, 07(01): 48-52.

目的

探讨腹腔镜肝切除术（LLR）治疗困难部位肝细胞癌（肝癌）的疗效。

方法

回顾性分析2015年2月至2017年2月在四川大学华西医院接受诊治的89例困难部位肝癌患者临床资料。根据手术方式不同将患者分为LLR组和开腹肝切除术组（OLR组）。其中LLR组36例，男27例，女9例；平均年龄（54±13）岁。OLR组53例，男44例，女9例；年龄（52±11）岁。患者均签署知情同意书，符合医学伦理学规定。两组围手术期情况和术后生活质量评分比较采用t检验或Kruskal-Wallis秩和检验，生存分析采用Kaplan-Meier法和Log-rank检验。

结果

LLR组的手术时间为（268±89）min，明显长于OLR组的（210±74）min（t=3.365，P<0.05）。LLR组的术后住院时间为（6.2±1.2）d，明显短于OLR组的（7.2±2.3）d（t=-2.347，P<0.05）。LLR的手术费用为（1.91±0.93）万元，明显高于OLR组的（0.61±0.17）万元（t=10.425，P<0.05）。LLR组日常活动评分、肝癌附加症状评分和生活质量总评分分别为（25±4）、（64±7）和（151±20）分，明显高于OLR组的（23±3）、（60±7）和（144±9）分（t=2.278，2.375，2.720；P<0.05）。OLR组总体生存率、无瘤生存率分别为93.0%、78.0%，LLR组相应为97.0%、79.0%，差异无统计学意义（χ2=0.276，0.029；P>0.05）。

结论

与OLR相比，LLR治疗困难部位的肝癌能明显缩短住院时间、提高术后生活质量，且安全、可行。

关键词: 肝肿瘤, 腹腔镜, 肝切除术
Objective

To explore the efficacy of laparoscopic liver resection (LLR) in the treatment of patients with hepatocellular carcinoma (HCC) at complicated region.

Methods

Clinical data of 89 patients with HCC at complicated region treated in West China Hospital of Sichuan University between February 2015 and February 2017 were analyzed retrospectively. These patients were divided into LLR group and open liver resection group (OLR group) according to different operative procedures. There were 36 patients in LLR group, including 27 males and 9 females, with an average age of (54±13) years old. There were 53 patients in OLR group, including 44 males and9 females, with an average age of (52±11) years old. The informed consents of all patients were obtained and the local ethical committee approval was received. Perioperative conditions and postoperative quality of life score in both groups were compared using t test or Kruskal-Wallis rank sum test, and survival analysis was conducted using Kaplan-Meier test and Log-rank test.

Results

The length of operation was (268±89) min in LLR group, significantly longer than (210±74) min in OLR group (t=3.365, P<0.05). The postoperative length of hospital stay was (6.2±1.2) d in LLR group, significantly shorter than (7.2±2.3) din OLR group (t=-2.347, P<0.05). The operation expenses was (19.1±9.3) thousand RMB in LLR group, which was significantly higher than (6.1±1.7) thousand RMB in OLR group (t=10.425, P<0.05). The score of daily activity, accessory symptoms of HCC and score of quality of life were (25±4), (64±7) and (151±20) points in LLR group, significantly higher than (23±3), (60±7) and (144±9) points in OLR group, respectively (t=2.278, 2.375, 2.720; P<0.05). The overall survival, disease-free survival were respectively 93.0%, 78.0% in OLR group, and respectively 97.0%, 79.0% in LLR group, where no significant difference was observed (χ2=0.276, 0.029; P>0.05).

Conclusions

Compared with OLR, LLR can obviously shorten the length of hospital stay and improve the postoperative quality of life for patients with hepatocellular carcinoma (HCC) at complicated region. It is safe and feasible.

Key words: Liver neoplasms, Laparoscopes, Hepatectomy
图1 腹腔镜五孔法Trocar位置示意图[2]
表1 LLR组和OLR组困难部位肝癌患者一般资料比较
组别 例数 年龄（岁，±s） 性别（例） BMI（kg/m2，±s） 肿瘤直径（cm，±s） 肿瘤位置（例）
男 女 I段 Ⅳa段 Ⅶ段 Ⅷ段
LLR组 36 54±13 27 9 23±3 4.2±2.3 1 6 17 12
OLR组 53 52±11 44 9 24±3 4.3±1.9 3 2 20 28
统计值 ? t=0.928 χ2=0.854 t=-1.478 t=-0.290 χ2=6.698
P值 ? >0.05 >0.05 >0.05 >0.05 >0.05
表2 LLR组和OLR组困难部位肝癌切除患者围手术期比较
组别 例数 手术时间（min，±s） 术中出血量[ml，M(QR）] 术中输血（例） 术后1 d引流量[ml，M(QR）] 术后引流管拔除时间（d，±s） 术后排气时间[d，M(QR）] 术后住院时间（d，±s） 并发症（例） 手术费用（万元，±s）
LLR组 36 268±89 200（100～300） 2 200（50～350） 6.8±3.9 5（1～9） 6.2±1.2 14 1.91±0.93
OLR组 53 210±74 200（100～300） 2 200（105～295） 5.6±1.6 6（1～11） 7.2±2.3 18 0.61±0.17
统计值 ? t=3.365 Z=-0.337 χ2=0.156 Z=-1.497 t=1.926 Z=-0.932 t=-2.347 χ2=0.226 t=10.425
P值 ? <0.05 >0.05 >0.05 >0.05 >0.05 >0.05 <0.05 >0.05 <0.05
表3 LLR组和OLR组困难部位肝癌切除患者术后3个月生活质量情况比较（分）
组别 例数 日常活动评分 社交/家庭生活评分 情绪状况评分 活动能力评分 肝癌附加症状评分 总评分
LLR组 36 25±4 22±4 20±4 20±6 64±7 151±20
OLR组 53 23±3 21±2 20±1 20±3 60±7 144±90
t值 ? 2.278 2.183 0.786 1.317 2.375 2.720
P值 ? <0.05 >0.05 >0.05 >0.05 <0.05 <0.05
图2 LLR组和OLR组困难部位肝癌切除患者术后总体生存和无瘤生存Kaplan-Meier曲线
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